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Diagnosis / Variceal Hemorrhage

In people who have cirrhosis, high blood pressure in the veins that carry blood fro the intestines to the liver (portal hypertension) causes many problems. One serious complication of portal hypertension is variceal bleeding.

When blood pressure increases in the portal vein system, veins in the esophagus, stomach, and rectum enlarge to accommodate blocked blood flow through the liver. The presence of enlarged veins (varices) usually cases no symptoms. About 50 – 60% of people who have cirrhosis develop varices in the esophagus.

As the blood pressure in the portal vein system continues to increase, the walls of the expanded veins become thinner and eventually rupture and bleed. This is called variceal bleeding.

  • The more severe the liver damage and the larger the varices, the greater your risk is for variceal bleeding
  • 30% of people who develop varices have an episode of bleeding within 2 years of the diagnosis

Symptoms of Variceal Bleeding

Typically nonbleeding varices are asymptomatic. Once varices are bleeding, patients present with symptoms of an upper gastrointestinal hemorrhage such as hematemesis, passage of black or bloody stools, lightheadedness, or decreased urination.

Diagnosis of Variceal Bleeding

Esophageal and gastric varices are best diagnosed by endoscopy, which may also identify varices at high risk of bleeding. Endoscopy is also used to exclude other causes of acute bleeding, such as a peptic ulcer.

The American College of Gastroenterology recommends endoscopic screening for varices for anyone who has been diagnosed with cirrhosis. If your first test does not identify any varices, you can be tested again in 2 to 3 years. You may require more frequent testing if you have large varices or have already had an episode of variceal bleeding, recurrent bleeding is common.

Laboratory tests such as CBC with platelets, PT, PTT and liver function can also be used to evaluate patients for a bleeding disorder (coagulopathy).

IVC’s Treatment of Variceal Bleeding

In about 40% of cases, variceal bleeding stops spontaneously. If bleeding continues, emergency techniques to shunt blood from the portal system to the vena cava can lower portal pressure and diminish bleeding. A transjugular intrahepatic portosystemic shunt (TIPS) procedure is the emergency intervention of choice. TIPS is the percutaneous formation of a tract between the hepatic vein and the intrahepatic segment of the portal vein in order to reduce the portal venous pressure.

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We are announcing that Interventional and Vascular Consultants will be closing as of March 10, 2023.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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